Clinical Features of DSM-IV Cannabis Abuse in a Cross-National Context

Fabian Fiestas

Fiestas, Fabian, and Radovanovic, Mirjana, Michigan
State University, United States; Medina-Mora, Maria Elena, Institute
of Psychiatry, Mexico; Posada-Villa, Jose, Colegio Mayor de Cundinamarca
University and the Social Protection Ministry, Colombia; Anthony,
James C., Michigan State University, United States

Aims: Recent
community surveys in Mexico and Colombia make it possible to
estimate cumulative incidence of clinical features of DSM-IV
cannabis abuse in these two countries, and to compare and contrast
the experience of cannabis smokers (CS) in each place.

Methods: Study data are from the World Mental Health Surveys Initiative,
with probability samples in Mexico (n=4,426) and Colombia (n=5,782).
After excluding persons with a history of any other "illegal" drug
use, the samples included 380 CS in Mexico and 413 CS in Colombia.
Standardized diagnostic assessments were used to identify these
CS, to implement exclusion rules, and to assess five manifestations
of non-hierarchical DSM-IV cannabis abuse with respect to cannabis-associated
social maladaptation or hazard-laden use (e.g., driving while
intoxicated). Estimates and 95-percent confidence intervals
were based on appropriate sample weighting and Taylor series
variance estimation.

Results: After exclusion of polydrug users,
an estimated one in eight to nine cannabis smokers attributed
social problems to cannabis use (13% Colombia; 11% Mexico),
whereas country-specific estimates for continuing to smoke
despite social problems were 11 percent and 8 percent, respectively.
Cannabis-associated work problems occurred somewhat less frequently:
9 percent in both Colombia and Mexico. In Colombia, an estimated
9 percent of cannabis smokers had engaged in hazard-laden cannabis
use, versus 10 percent in Mexico. Cannabis-associated legal
problems were experienced by 1 in 16 of the cannabis smokers
in each country (i.e., ~6%).

Conclusions: This study's
most remarkable finding is similarity in cumulative incidence
of cannabis-associated problems among cannabis smokers in this
cross-national comparison. Estimates derived separately indicate
modestly greater hazard-laden CS among non-Hispanics in the
United States, with modestly lower risk of legal problems for
CS in the United States.